<div class="hbox hbox-auto-xs hbox-auto-sm" ng-init="
    app.settings.asideFolded = false; 
    app.settings.asideDock = false;
  ">

  <!-- main -->
  <div class="col">
    <!-- main header -->
    <div class="bg-light lter b-b wrapper-md">
      <div class="row">
        <div class="col-sm-6 col-xs-12">
          <h1 class="m-n font-thin h3 text-black">退费申请</h1>
        </div>
      </div>
    </div>
    <!-- / main header -->

    <div class="wrapper-md">
      <form name="" class="form-horizontal form-validation">
        <div class="panel panel-default">
          <div class="panel-heading">

            <div class="row">
              <div class="col-lg-4 col-sm-6">
                <div class="form-group">
                  <label class="col-sm-5 control-label nowrap">退费类型:</label>
                  <div class="col-sm-7">
                    <div class="checkbox">
                      <label class="i-checks"><input type="radio" /><i></i> 退费</label>
                      <label class="i-checks"><input type="radio" /><i></i> 补偿</label>
                      <label class="i-checks"><input type="radio" /><i></i> 误操作撤销（交账前）</label>
                    </div>
                  </div>
                </div>
              </div>
            </div>
            
          </div>
        </div>

        <div class="panel panel-default">
          <div class="panel-heading"><strong>业主查询</strong></div>
          <div class="panel-body">
            <div class="row">
              <div class="col-lg-4 col-sm-6">
                <div class="form-group">
                  <label class="col-sm-5 control-label nowrap">房屋编号:</label>
                  <div class="col-sm-7">
                    <input type="text" class="form-control" placeholder="">
                  </div>
                </div>
              </div>

              <div class="col-lg-4 col-sm-6">
                <div class="form-group">
                  <label class="col-sm-5 control-label nowrap">业主信息:</label>
                  <div class="col-sm-7">
                    <div class="row">
                      <div class="col-sm-6"><input type="text" name="" class="form-control"></div>
                      <div class="col-sm-6">
                        <div class="nowrap">(姓名、电话)</div>
                      </div>
                    </div>
                  </div>
                </div>
              </div>
            </div>
          </div>

          <div class="panel-footer  text-right">
            <button class="btn btn-info m-r">&nbsp;&nbsp;重置&nbsp;&nbsp;</button>
            <button class="btn btn-success m-l">&nbsp;&nbsp;查询&nbsp;&nbsp;</button>
          </div>
          <div class="pabel-footer">
            <div class="container-fluid">
              <table class="table table-bordered m-t">
                <tr>
                  <td>1-1-1302 张二二 13121212121</td>
                  <td>1-1-1302 张二二 13121212121</td>
                  <td>1-1-1302 张二二 13121212121</td>
                </tr>
                <tr>
                  <td>1-1-1302 张二二 13121212121</td>
                  <td>1-1-1302 张二二 13121212121</td>
                  <td>1-1-1302 张二二 13121212121</td>
                </tr>
                <tr>
                  <td>1-1-1302 张二二 13121212121</td>
                  <td>1-1-1302 张二二 13121212121</td>
                  <td>1-1-1302 张二二 13121212121</td>
                </tr>
              </table>
            </div>
          </div>
        </div>
      </form>

      <div class="panel panel-default">
        <div class="panel-heading"><strong>已选业主信息</strong></div>
        <div class="panel-body">
          <div class="row form-horizontal">
            <div class="col-lg-4 col-sm-6">
              <div class="form-group">
                <label class="col-sm-5 control-label nowrap">房屋编号:</label>
                <div class="col-sm-7">
                  <p class="form-control-static">1-2-1302</p>
                </div>
              </div>
            </div>

            <div class="col-lg-4 col-sm-6">
              <div class="form-group">
                <label class="col-sm-5 control-label nowrap">业主姓名:</label>
                <div class="col-sm-7">
                  <p class="form-control-static">张二二</p>
                </div>
              </div>
            </div>

            <div class="col-lg-4 col-sm-6">
              <div class="form-group">
                <label class="col-sm-5 control-label nowrap">联系电话:</label>
                <div class="col-sm-7">
                  <p class="form-control-static">13112341234</p>
                </div>
              </div>
            </div>

            <div class="col-lg-4 col-sm-6">
              <div class="form-group">
                <label class="col-sm-5 control-label nowrap">建筑面积:</label>
                <div class="col-sm-7">
                  <p class="form-control-static">100.00</p>
                </div>
              </div>
            </div>

            <div class="col-lg-4 col-sm-6">
              <div class="form-group">
                <label class="col-sm-5 control-label nowrap">车位:</label>
                <div class="col-sm-7">
                  <div class="checkbox">2</div>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>

      <form name="" class="form-horizontal form-validation">

        <div class="panel panel-default">
          <div class="panel-heading">
            <strong>已交费用查询：</strong>
          </div>
          <div class="panel-body">
            <div class="row">
              <div class="col-lg-4 col-sm-6">
                <div class="form-group">
                  <label class="col-sm-5 control-label nowrap">收费项目:</label>
                  <div class="col-sm-7">
                    <select class="form-control">
                      <option value="">全部</option>
                      <option value="">物业费</option>
                      <option value="">装修押金</option>
                    </select>
                  </div>
                </div>
              </div>

              <div class="col-lg-4 col-sm-6">
                <div class="form-group">
                  <label class="col-sm-5 control-label nowrap">计费方式:</label>
                  <div class="col-sm-7">
                    <select class="form-control">
                      <option value="">全部</option>
                      <option value="">默认计费</option>
                      <option value="">抄水表</option>
                    </select>
                  </div>
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-lg-4 col-sm-6">
                <div class="form-group">
                  <label class="col-sm-5 control-label nowrap">交费日期:</label>
                  <div class="col-sm-7">
                    <div class="row">
                      <div class="col-sm-5"><input type="date" name="" class="form-control"></div>
                      <div class="col-sm-1">-</div>
                      <div class="col-sm-5"><input type="date" name="" class="form-control"></div>
                    </div>
                  </div>
                </div>
              </div>

              <div class="col-lg-4 col-sm-6">
                <button class="btn btn-info">近一周</button>
                <button class="btn btn-info">近一个月</button>
                <button class="btn btn-info">三个月</button>
              </div>
            </div>
          </div>

          <div class="panel-footer text-right">
            <button class="btn btn-success m-l">&nbsp;&nbsp;确定&nbsp;&nbsp;</button>
          </div>

          <div class="panel-footer">
            <div class="table-responsive">
              <table class="table table-bordered">
                <thead>
                  <tr>
                    <th>序号</th>
                    <th>收费项目</th>
                    <th>计费方式</th>
                    <th>交费笔数</th>
                    <th>时长</th>
                    <th>数量</th>
                    <th>截止日期</th>
                    <th>交费金额</th>
                  </tr>
                </thead>

                <tbody>
                  <tr>
                    <td>1</td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                  </tr>
                  <tr>
                    <td>1</td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                  </tr>
                  <tr>
                    <td>1</td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                  </tr>
                  <tr>
                    <td>1</td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                    <td></td>
                  </tr>
                </tbody>
              </table>
            </div>
          </div>
        </div>
      </form>

      <div class="panel panel-warning">
        <div class="panel-heading">已选退费項目</div>
        <div class="panel-boding">
          <div class="table-responsive">
            <table class="table table-bordered">
              <thead>
                <tr>
                  <th>序号</th>
                  <th>收费项目</th>
                  <th>计费方式</th>
                  <th>退费至</th>
                  <th>退费时长</th>
                  <th>退费数量</th>
                  <th>退费金额</th>
                </tr>
              </thead>

              <tbody>
                <tr>
                  <td>1</td>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                </tr>
                <tr>
                  <td>1</td>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                </tr>
                <tr>
                  <td>1</td>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                </tr>
                <tr>
                  <td>1</td>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                </tr>
              </tbody>
            </table>
          </div>
        </div>
      </div>

      <form class="form-horizontal">
        <div class="panel panel-default">
          <div class="panel-body">
            <div class="form-group">
              <label class="col-sm-12">合计金额: 2</label>
            </div>

            <div class="form-group">
              <label class="col-sm-12">退费原因:</label>
              <div class="col-sm-12">
                <textarea class="form-control" rows="6" placeholder=""></textarea>
              </div>
            </div>

            <div class="row">
              <div class="col-lg-4 col-sm-6">
                <div class="form-group">
                  <label class="col-sm-5 control-label nowrap">制单人:</label>
                  <div class="col-sm-7">
                    <input type="text" class="form-control" placeholder="">
                  </div>
                </div>
              </div>

              <div class="col-lg-4 col-sm-6">
                <div class="form-group">
                  <label class="col-sm-5 control-label nowrap">审批人:</label>
                  <div class="col-sm-7">
                    <input type="text" class="form-control" placeholder="">
                  </div>
                </div>
              </div>
            </div>
          </div>

          <div class="panel-footer text-center">

            <div class="m-t text-center">
              <button class="btn btn-info">申请</button>
              <button class="btn btn-info">返回</button>
            </div>

          </div>

        </div>
      </form>
    </div>
  </div>

</div>